Categories
Drug treatments Moderna Pfizer

Fighting Misinformation

Lots of misinformation bubbling up lately. Here is the science you can use to dismiss a few of them…

Ivermectin. 

This is an anti-parasitic medication, which MAY have the ability to reduce COVID19 mortality. A recent study, called ICON, pulled medical records from patients in four Florida hospitals: 172 COVID patients treated with Ivermectin and 107 treated without. Scientists found that mortality decreased among patients with Ivermectin. HOWEVER, the patients that got Ivermectin were also more likely to get steroids too, which we know helps fight COVID19. So, we aren’t sure if people were less likely to die because of steroids or because of ivermectin. There has also been one test tube study and two small randomized control trials (Egypt and Iraq). Ivermectin is definitely something to watch, but we certainly don’t have enough evidence to change COVID19 treatment. Don’t start taking your pet’s ivermectin prescription. We need stronger, larger studies.

65+ with comorbidities in vaccine trials. 

Many people have asked (or stated) that vaccine trials didn’t include anyone that was 65+ with comorbidities. I’m not sure where this misinformation budded from because this is 100% incorrect. Not even close to being true. Both Moderna and Pfizer included patients 65+ with comorbidities (see Tables attached) and vaccines worked swimmingly well. In Pfizer, vaccine efficacy was 91.7% among those aged 65+ with a comorbidity. 

Moderna (can be found in the supplement)
Pfizer for all patients (can be found in the supplement)

No asymptomatic spread. 

Anti-lockdown warriors have recently used a JAMA publication to justify no asymptomatic spread. This scientific article was a meta-analysis; an incredibly strong study that pools previous studies (I’ve posted on this type of study before, search my blog for “meta-analysis” for more info). Briefly, the article combined 54 previous studies to assess secondary attack rates (how often an infected person infects others at home). The misinformation budded from a sub-analysis of only 4 studies, which found secondary attack rates was lower among asymptomatic people compared to non-asymptomatic people in households. This is much different than stating that there is no asymptomatic transmission in the community. 

Hope this helps!

Love, YLE

Data Sources…

Ivermectin: ICON study: https://journal.chestnet.org/article/S0012-3692(20)34898-4/fulltext; Iraq study: https://www.medrxiv.org/content/10.1101/2020.10.26.20219345v1; Egypt study: https://www.researchsquare.com/article/rs-100956/v1; In vitro study: https://pubmed.ncbi.nlm.nih.gov/32251768/

65+ with comorbidities:  Moderna Phase III: https://www.nejm.org/doi/full/10.1056/NEJMoa2035389; Pfizer Phase III: https://www.nejm.org/doi/full/10.1056/NEJMoa2034577?query=featured_home

Asymptomatic JAMA article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774102

Categories
Antibodies Drug treatments Innovative Solutions

Plasma and COVID-19

What is plasma? When people get sick, immune systems generate antibodies to fight the disease. Those antibodies (especially among very sick patients) float in people’s blood plasma — the liquid component of blood. 

How can it be used? Plasma from a recovered person (who was very sick) can be injected into a currently sick person. The antibodies fight the virus early until the patient’s own immune system has enough to fight. Plasma has been used to fight epidemics, like the 1918 Spanish Flu, diphtheria epidemic in the 1920s, and the Ebola outbreak in 2014.

Plasma to fight COVID19? This has slowly come to the surface in the 2020. Here’s a timeline…

January 20-March 25: China treated 5 COVID19 patients with plasma. It worked.

March 24: FDA issued guidelines for using plasma in emergency investigations of new drug protocols (called eIND)

March 31: COVID19 plasma was used for the first time in the U.S. (Houston Methodist). It worked (for the most part).

May 14: A meta-analysis was published. Only 8 plasma studies had been conducted thus far and they were mainly “case studies” (basically a story with what happened with a few patients). There were no randomized control trials (RCT). The conclusion? We have no idea if plasma works because we don’t have enough evidence.

July 10: An updated meta-analysis was published pooling all studies on plasma. There were 20 published studies by now, but only 1 RCT. Their conclusion? We have no idea if plasma works because we don’t have enough evidence.

August 13: Mayo Clinic released a study with over 35,000 patients. They found that plasma helped with patient outcomes (like less death). BUT this was not peer-reviewed, which is important because this study has some serious limitations. Most importantly, there was no placebo group. The specific role of plasma is unclear because all patients received at least one additional medicine at the same time. This makes it difficult to know whether it was the plasma or the drug that helped the patients.

August 23: Nonetheless, the FDA allowed emergency authorization for doctors to treat Covid-19 using plasma

August 25: Three randomized control trials had concluded (one in China, Netherlands, and Iraq). The Chinese study was stopped early because they couldn’t get enough people to enroll. The Netherlands study was stopped early because most of the participants already had antibodies. The Iraq study was too small to see whether plasma helped.

Today: From my count, there are 98 ongoing studies evaluating plasma, of which 50 are randomized. We don’t have the results of these studies yet.

But… if it’s worked for other pandemics, why not just use plasma for everyone? Safety. 14 of the current 20 studies have reported serious adverse events with plasma. In one study, scientists reported that 4 deaths were directly linked to plasma infusion (out of 15 deaths total). It’s important we get this science right.

So, now what? We wait. We NEED rigorous studies to conclude. These are very difficult to conduct, though, because we need enough people to donate plasma AND we need enough people to agree to be infused. But, thanks to the perseverance of many scientists and brave community members, results should be coming out soon. TBD.

Love, YLE

First plasma treatment in China: https://jamanetwork.com/journals/jama/fullarticle/2763983

May study: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013600/full

July study: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013600.pub2/epdf/full

Mayo clinic study: https://www.medrxiv.org/content/10.1101/2020.08.12.20169359v1

FDA August announcement: https://www.fda.gov/media/141480/download

Categories
Deaths Drug treatments Hospitalizations

COVID-19 drug update!

Alright, here we go! You may (or may not) remember that on August 4 some brilliant scientists created a “live meta-analysis” for COVID19 drug treatments. They basically want to know which drugs are effective and not effective. Well, their findings have been updated!!

What is a meta-analysis? One massive study that combines the results of ALL previous studies. This is a really powerful tool because it takes into account whether past studies were “strong” or “weak”. It also takes into account different populations (think different genes, different environments, different cultures, different confounders). Basically, this allows us to get an overarching idea of what is working and what is not working. This meta-analysis ONLY includes RCTs- the gold standard for epidemiological drug studies.

What is a “live” meta analysis? The scientists proposed that as new studies come in, their meta-analysis would be automatically updated. This has NEVER been done before (but is such a brilliant idea). AND they updated their analysis for the first time!

What is new in this update? They added 12 new randomized control trials (RCTs) from the last iteration, making the total number of pooled studies= 27 (which is 11,006 people).

Did this update change our understanding of anything? No. It’s “only” strengthened our understanding of effective (and not effective) drugs:

  1. Glucocorticoids was the ONLY intervention that reduced mortality and the need for mechanical ventilation
  2. Remdesivir reduces duration of symptoms and probably does not increase adverse effects
  3. Hydroxychloroquine does not reduce risk of death or mechanical ventilation (is this still a point of contention?)

This live meta-analysis will continue to update for 2 years. And there are already 6 new RCT’s in queue for the next iteration.

They have an interactive tool on the website, that I highly suggest playing around with too!

Love, YLE

Data source: https://www.bmj.com/content/370/bmj.m2980